142 articles - From Friday Jun 09 2023 to Friday Jun 16 2023
Guidelines and related publications, position statements, white papers, technical reviews, consensus statements, etc…
| Endoscopy |
Curriculum for training in endoscopic mucosal resection in the colon: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. 11: Trained practitioners should log their key performance indicators (KPIs) of polypectomy during independent practice. A guide for target KPIs is provided in this document. |
| Gastrointest Endosc |
ASGE Guideline on role of endoscopy in the diagnosis of malignancy in biliary strictures of undetermined etiology: Methodology and Review of Evidence. Using a systematic review and meta-analysis of each diagnostic modality, including fluoroscopic-guided biopsies, brush cytology, cholangioscopy, and endoscopic ultrasound fine needle aspiration or biopsy, the American Society of Gastrointestinal Endoscopy (ASGE) Standards of Practice committee provides this guideline on modalities used to diagnose biliary strictures of undetermined etiology. This document summarizes the methods used in the GRADE analysis to make recommendations, while the "Summary and Recommendations" document contains a concise summary of our findings and final recommendations. |
ASGE Guideline on the role of endoscopy in the diagnosis of malignancy in biliary strictures of undetermined etiology: Summary and Recommendations. In the endoscopic work-up of these patients, we suggest the use of fluoroscopic-guided biopsies in addition to brush cytology over brush cytology alone, especially for hilar strictures. Especially for patients with, non-diagnostic sampling we suggest the use of cholangioscopic and EUS-guided biopsies; the former for non-distal and the latter for distal strictures or those with suspected spread to surrounding lymph nodes and other structures. |
meta-analyses and systematic reviews
| J Hepatol |
Machine perfusion techniques for liver transplantation - A meta-analysis of the first seven randomized controlled trials. Although this study provides the highest current evidence on the role of machine perfusion, outcomes remain limited to a one-year follow-up after liver transplantation. Comparative RCTs and large real world cohort studies with longer follow-up are required to enhance the robustness of the data further, thereby supporting the introduction of perfusion technologies in routine clinical practice. |
RCT, clinical trials, retrospective studies, etc…
| Aliment Pharmacol Ther |
A randomised, double-blind, placebo-controlled study of the LAG-3-depleting monoclonal antibody GSK2831781 in patients with active ulcerative colitis. Despite evidence of target cell depletion in blood, GSK2831781 failed to reduce inflammation in the colonic mucosa suggesting no pharmacological effect. The study was terminated early (NCT03893565). |
Accuracy of ultrasound, bioelectrical impedance analysis and anthropometry as point-of-care measurements of skeletal muscle mass in patients with inflammatory bowel disease. Ultrasound of the arm and legs out-performed other point-of-care methods in its accuracy of measuring muscle mass. All methods, except mid-arm circumference, were responsive to therapy-induced change. Ultrasound is the preferred non-invasive test for measuring muscle mass in patients with IBD. |
Baveno VI and VII criteria are not suitable for screening for large varices or clinically significant portal hypertension in patients with hepatocellular carcinoma. Favourable Baveno VI criteria are not appropriate to rule out the presence of high-risk EV, or Baveno VII criteria to rule CSPH in/out in patients with HCC. |
Efficacy of biologic and small molecule agents as second-line therapy after exposure to TNF inhibitors in patients with ulcerative colitis: A propensity-matched cohort study. Ustekinumab might be the preferred second-line therapy over tofacitinib and vedolizumab in patients with UC that were previously exposed to a TNFi. |
Real-world effectiveness of vedolizumab compared to anti-TNF agents in biologic-naïve patients with ulcerative colitis: A two-year propensity-score-adjusted analysis from the prospective, observational VEDOIBD -study. After two years of treatment, vedolizumab resulted in higher remission rates than anti-TNF agents. |
| Am J Gastroenterol |
An Automated Tissue Systems Pathology Test can Standardize the Management and Improve Health Outcomes for Barrett's Esophagus Patients. Management guided by the TSP-9 test can standardize care plans by increasing the early detection of progressors who can receive therapeutic interventions, while also increasing the percentage of non-progressors who can avoid unnecessary therapy and be managed by surveillance alone. |
Association of ALT Flares to Hepatitis B Surface Decline During Tenofovir Alone or with Pegylated Interferon Alfa. Flare severity is a potentially important factor associated with shorter time to HBsAg reduction. These findings can be useful when evaluating HBsAg response to evolving HBV therapies. |
Immune Checkpoint Inhibitors Suppress Hepatitis C Virus Replication in Infected Patients with Solid Tumors. Inhibition of HCV replication with virologic cure can develop in patients receiving ICIs without DAAs. HCV reactivation occurs primarily in patients receiving immunosuppressants for ICI-related toxic effects. ICIs are safe in HCV-infected patients with solid tumors. Chronic HCV infection should not be considered a contraindication for ICI therapy. |
Increased Risk of Osteoporotic Fracture in Patients with Autoimmune Hepatitis. Patients with AIH had an increased risk of osteoporotic fracture compared to controls. Presence of cirrhosis and long-term use of glucocorticoids further adversely affected osteoporotic fracture in patients with AIH. |
Poliprotect vs Omeprazole in the relief of heartburn, epigastric pain and burning in patients without erosive esophagitis and gastro-duodenal lesions: A Randomized, Controlled Trial. Poliprotect proved non-inferior to standard-dose Omeprazole in symptomatic patients with heartburn/epigastric burning without erosive esophagitis and gastro-duodenal lesions. Gut microbiota was not affected by Poliprotect treatment. The study is registered in Clinicaltrial.gov (NCT03238534) and the EudraCT Database (2015-005216-15). |
Six-Food Elimination Diet is Less Effective During Pollen Season in Adults with Eosinophilic Esophagitis Sensitized to Pollens. Pollens may have a role in sustaining esophageal eosinophilia in sensitized adults with EoE despite avoidance of trigger foods. SPT for pollens may identify patients less likely to respond to the diet during the pollen season. |
Varied Trainee Competence in Cold Snare Polypectomy - Results of the COMPLETE Randomized Controlled Trial. Video feedback aided trainees to competence in CSP. However, the learning curve was long. Our findings strongly suggest that current training methods are not sufficient to support trainees to competency by the completion of their fellowship programs. The impact of new training methods, such as simulation-based mastery learning, should be assessed to determine if such methods can result in achievement of competence at a faster rate; ClinicalTrials.gov NCT03115008. |
| Clin Gastroenterol Hepatol |
A Diagnosis of Irritable Bowel Syndrome Using Rome IV Criteria and Limited Investigations is Durable in Secondary Care. Despite re-referral for gastrointestinal symptoms among one-in-six patients overall, with almost 10% re-referred with ongoing IBS symptoms, and substantial reinvestigation rates, missed organic gastrointestinal disease occurred in only 1%. A diagnosis of Rome IV IBS after limited investigation is safe and durable. |
Curcumin-QingDai combination for patients with active ulcerative colitis: A randomized double-blinded placebo-controlled trial. In this placebo-controlled trial, CurQD was effective for inducing response and remission in active UC patients. The AhR-pathway may merit further study as potential UC treatment target. |
Defining Small Intestinal Bacterial Overgrowth by Culture and High Throughput Sequencing. Our findings confirm =10 3 CFU/mL is the optimal SIBO threshold, associated with gastrointestinal symptoms, significantly decreased microbial diversity, and network disruption. Microbial hydrogen- and hydrogen sulfide-related pathways were enhanced in SIBO subjects, supporting past studies. Remarkably few specific E. coli and Klebsiella strains/species appear to dominate the microbiome in SIBO, and correlate with abdominal pain, diarrhea, and bloating severities. |
Hepatocellular Carcinoma Incidence Threshold for Surveillance in Virologically Cured Hepatitis C Individuals. The contemporary HCC incidence threshold is much lower than the previous 1.5% incidence value used to guide HCC surveillance decisions. Updating clinical guidelines could improve the early diagnosis of HCC. |
Standardizing Scoring Conventions for Crohn's Disease Endoscopy: An International RAND/UCLA Appropriateness Study. We outlined scoring conventions for the SES-CD and CDEIS, noting both scores have limitations. Therefore, we identified priorities for future research and steps for developing and validating a more representative endoscopic index in CD. |
The Clinical Impact and Cost-Effectiveness of Surveillance of Incidentally-Detected Gastric Intestinal Metaplasia: A Microsimulation Analyses. (ICER $28,156/QALY and $87,020/QALY, respectively) CONCLUSIONS: Using microsimulation modeling, surveillance of incidentally detected GIM every 5-years is associated with reduced GA incidence/mortality and is cost-effective from a healthcare sector perspective. Real-world studies evaluating the impact of GIM surveillance on GA incidence and mortality in the US are needed. |
| Endosc Int Open |
Single-use duodenoscopes compared with reusable duodenoscopes in patients carrying multidrug-resistant microorganisms: a break-even cost analysis. This study showed that a crossover scenario in which single-use duodenoscopes are only used in patients carrying MDROs could be an economically viable alternative to a complete transition to single-use duodenoscopes. In the Dutch setting, single-use duodenoscopes need to be priced much lower than in the United States to reach a per-procedure cost that is comparable with a scenario using reusable duodenoscopes exclusively. |
| Endoscopy |
Endoscopic submucosal dissection assisted by adaptive traction: results of the first 54 procedures. ESD using the ATRACT device is safe and effective for the colon and rectum but can also be used to assist with procedures in the upper gastrointestinal tract. It may be particularly useful in difficult locations. |
| Gastroenterology |
ASSOCIATION OF PROTON PUMP INHIBITOR USE WITH INCIDENT DEMENTIA AND COGNITIVE DECLINE IN OLDER ADULTS: A PROSPECTIVE COHORT STUDY. In adults = 65 years of age, PPI and H2RA use were not associated with incident dementia, CIND, or decline in cognition over time. These data provide reassurance about the safety of long-term use of PPIs among older adults. |
Early ileocecal resection for Crohn's disease is associated with improved long-term outcomes compared to anti-tumor necrosis factor therapy: a population-based cohort study. These data suggest that ICR may have a role as first-line therapy in CD management and challenge the current paradigm of reserving surgery for complicated CD refractory or intolerant to medications. Yet, given inherent biases associated with observational data, our findings should be interpreted and applied cautiously in clinical decision-making. |
Global Burden of Digestive Diseases: A Systematic Analysis of the Global Burden of Diseases Study, 1990-2019. Despite significant reductions in deaths and DALYs due to digestive diseases from 1990 to 2019, they remain prevalent. A significant disparity in the burden of digestive diseases exists among countries with different development levels. |
Prevalence and Associated Factors of Bloating: Results from the Rome Foundation Global Epidemiology Study. Bloating is common throughout the world. Nearly 18% of the general population experience bloating at least once per week. Reported bloating prevalence is lower in older age groups, is most common in women, and is strongly associated with abdominal pain. |
| Gastrointest Endosc |
Location and appearance of dysplastic Barrett's recurrence after endoscopic eradication therapy: no additional yield from random biopsies of neosquamous mucosa. The yield of routine surveillance biopsies of normal appearing tubular esophageal neosquamous epithelium was zero. Barrett's islands with indistinct mucosal or loss of vascular pattern, nodularity or depression and/or signs of buried Barrett's should raise clinician suspicion for advanced dysplasia or neoplasia recurrence. We suggest a new surveillance biopsy protocol with a focus on meticulous inspection, followed by targeted biopsies of visible lesions and random four quadrant biopsies of the GEJ. |
| Hepatology |
Molecular and immune landscape of hepatocellular carcinoma to guide therapeutic decision making. In this review, we discuss the latest findings in the molecular and immune landscape of HCC for their potential and utility as biomarkers, framework of evaluation and clinical application of predictive/prognostic biomarkers, and ongoing biomarker-guided therapeutic clinical trials. These new developments may revolutionize patient care and substantially impact the still dismal HCC mortality. |
| J Hepatol |
Evaluation of RNAi Therapeutics VIR-2218 and ALN-HBV for Chronic Hepatitis B: Results From Randomized Clinical Trials. VIR-2218 demonstrated an encouraging hepatic safety profile in preclinical and clinical studies as well as dose-dependent HBsAg reductions in patients with cHBV infection. These data support future studies with VIR-2218 as part of combination regimens with a goal of HBV functional cure. |
Hepatocyte-derived biomarkers predict liver-related events at 2 years in Child-Pugh class A alcohol-related cirrhosis. In patients with Child-Pugh class A alcohol-related cirrhosis, combining hepatocyte-derived biomarkers with FibroTest or MELD score identifies patients at high-risk of liver-related events, and could be used for risk stratification and patient selection in clinical trials. |
Identification and experimental validation of druggable epigenetic targets in hepatoblastoma. HB display a profound dysregulation of the epigenetic machinery. Pharmacological targeting of key epigenetic effectors exposes metabolic vulnerabilities that can be leveraged to improve the treatment of these patients. Impact and implications In spite of recent advances in the management of hepatoblastoma (HB) patients, therapy resistance and drug toxicity are still major concerns. This systematic study reveals the remarkable dysregulation in the expression of epigenetic genes in HB tissues. Through pharmacological and genetic experimental approaches, we demonstrate that the histone-lysine-methyltransferase G9a is an excellent drug target in HB, which also can be harnessed to enhance the efficacy of chemotherapy. Furthermore, our study highlights the profound pro-tumorigenic metabolic rewiring of HB cells orchestrated by G9a in coordination with the c-MYC oncogene. With a broader perspective, our findings suggest that anti-G9a therapies may also be effective in other c-MYC-dependent tumors. |
Morphologic and molecular analysis of liver injury after SARS-CoV-2 vaccination reveals distinct characteristics. Our analyses support that SARS-CoV-2 vaccination-induced liver injury is related to AIH but also shows distinct differences from AIH in histomorphology, pathway activation, cellular immune infiltrates, and TCR usage. VILI may be a separate entity, which is distinct from AIH and more closely related to DI-AILH. Impact and implications Little is known about the pathophysiology of COVID-19 vaccine-induced liver injury. Our analysis shows that COVID-19 vaccine-induced liver injury shares some similarities with autoimmune hepatitis, but also has distinct differences such as increased activation of metabolic pathways, a more prominent CD8+ T cell infiltrate, and an oligoclonal T and B cell response. Our findings suggest that vaccine-induced liver injury is a distinct disease entity. Therefore, there is a good chance that many patients with COVID-19 vaccine-induced liver injury will recover completely and do not develop long-term autoimmune hepatitis. |
Natural history of NASH cirrhosis in liver transplant waitlist registrants. LT waitlist registrants with NASH cirrhosis are less likely to receive transplant compared to patients with non-NASH cirrhosis. Serum creatinine has the largest contribution to MELD score leading to LT. Impact and implications This study provides important insights into the distinct natural history of NASH cirrhosis among LT waitlist registrants, revealing that patients with NASH cirrhosis face lower odds of transplantation and higher waitlist mortality than non-NASH patients. The study underscores the significance of serum creatinine as a crucial contributor to MELD score in NASH cirrhosis patients. These findings have substantial implications, emphasizing the need for ongoing evaluation and refinement of the MELD score to more accurately capture mortality risk in NASH cirrhosis patients on the LT waitlist. Moreover, the study highlights the importance of further research investigating the impact of the implementation of MELD 3.0 across the United States on the natural history of NASH cirrhosis. |
Novel, high accuracy models for hepatocellular carcinoma prediction based on longitudinal data and cell-free DNA signatures. AMAP-2 and aMAP-2 Plus scores are highly accurate in predicting HCC. The stepwise application of aMAP scores provides an improved enrichment strategy of high-risk HCC patients, which could effectively guide nationwide individualized HCC surveillance. |
The novel SALT-M score predicts 1-year post-transplant mortality in patients with severe acute-on-chronic liver failure. The ACLF-LT-M score predicts mortality within 1-year after LT in patients with ACLF.The ACLF-LT-LoS score predicted median post-LT stay. Future studies using the ACLF-LT scores could assist in determining transplant benefits. Impact and implications Acute-on-chronic liver failure (ACLF) is a common syndrome, characterized by multi-organ failure in patients with cirrhosis associated with high-short term mortality. Liver transplantation (LT) may be the only life-saving procedure available to these patients but clinically unstability can augment the perceived risk of post-transplant mortality at one year. We provided a parsinominous score with clinically, and readily available parameters to objectively assess 1-year post LT survival and predict median length of stay after LT. Using modern estimation techniques, we developed and externally validated a clinical score model called the Sundaram ACLF-LT-Mortality score in 521 U.S. patients with ACLF with 2 or 3+ organ failure (s) and 120 French patients with grade ACLF-3. The area under the receiver operating characteristics curve was 0.72 in the development cohort and 0.80 in the validation cohort. We also provided an estimation of the median length of stay after LT in these patients. Our models can be incorporated in the discussion of risks/benefits in patients with severe ACLF listed for LT. Nevertheless, the score is far from perfect and other factors, such as patient's preference and center-specific factors, need to be considered whe using these tools. |
| Neurogastroenterol Motil |
Diagnostic methods to measure spastic segment and guide tailored myotomy length in type 3 achalasia. Length of spastic segment was positively correlated on HRM and BE while negatively correlated when compared to EUS, supporting the common use of HRM and highlighting the uncertain role for EUS in tailoring myotomy length for type 3 achalasia. |
Stimulator of interferon genes (STING) expression in the enteric nervous system and contributions of glial STING in disease. Taken together, our data support canonical roles for STING and IFNß signaling in the enteric nervous system through enteric neurons but that enteric glia do not use these same mechanisms. We propose that enteric glial STING may utilize alternative signaling mechanisms and/or is only active in particular disease conditions. Regardless, this study provides the first glimpse of STING signaling in the enteric nervous system and highlights a potential avenue of neuroglial-microbial communication. |
Plenty of the editorials are available as full text through the publisher website using the provided link
| Aliment Pharmacol Ther |
| Clin Gastroenterol Hepatol |
Optimizing the Utility of Anorectal Manometry for Diagnosis and Therapy: A Roundtable Review and Recommendations. Overcoming these challenges with appropriate education, training, collaborative research, and evidence-based guidelines for ARM testing and biofeedback therapy could significantly enhance patient care of anorectal disorders. |
| Gastroenterology |
| Gut |
SARS-CoV-2 and the liver: clinical and immunological features in chronic liver disease. Following SARS-CoV-2 vaccination, rare cases of acute vaccine-induced liver injury and the development of autoimmune-like hepatitis have been reported. However, the concomitant elevation of liver enzymes is reversible under steroid treatment. |
Timing of energy intake and the therapeutic potential of intermittent fasting and time-restricted eating in NAFLD. By highlighting data from preclinical and pilot human studies, we present a further biological rationale for manipulating timing of energy intake to improve metabolic health and discuss how this may be mediated through restoration of natural circadian rhythms. Lastly, we comprehensively review the landscape of human trials of intermittent fasting and time-restricted eating in metabolic disease and offer a look to the future about how these dietary strategies may benefit patients with NAFLD and non-alcoholic steatohepatitis. |
| J Hepatol |
The role of neutrophils in alcohol-related hepatitis. For example, correction of gut dysbiosis in AH could help to prevent excess neutrophil activation, or treatments could aim to enhance miR-223 function in AH. The development of markers that can reliably distinguish neutrophil subsets, and the development of animal models that accurately reproduce human disease are important areas for facilitating translation of research in this important field. |
| Neurogastroenterol Motil |
Major mixed motility disorders: An important subset of esophagogastric junction outflow obstruction. Patients with MMMD and IEGJOO present similarly. Detectable differences in HRM portend different responses to endoscopic therapy. Because patients with MMMD have greater short-term prognosis, they should be considered a different diagnostic classification to guide therapy. |
Transcutaneous electrical stimulation for gastrointestinal motility disorders. The time is ripe to evaluate further the full therapeutic potential of TES, a noninvasive, nonpharmaceutical, nonsurgical, and home-based self-administrative technique in managing GI motility disorders. |
misc publications eg case reports, tools of the trade, images of the month, etc…
| Am J Gastroenterol |
| Clin Gastroenterol Hepatol |
| Endosc Int Open |
| Endoscopy |
| Gastroenterology |
| Gut |
| Hepatology |
Letters to the editors and authors’ replies
| Aliment Pharmacol Ther |
| Clin Gastroenterol Hepatol |
| Endosc Int Open |
| Gastroenterology |
| Gut |
| J Hepatol |